Meropenem-associated severe neutropenia in an infant with brain abscess

Article type: Research Article

Authors: Burckhardt, Marie-Anne | Ettel, Elvire | Baer, Gurli | Haschke, Manuel | Rätz Bravo, Alexandra | Heininger, Ulrich | Ritz, Nicole

Affiliations: Neonatology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland | Paediatric Infectious Diseases Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland | Division of Clinical Pharmacology and Toxicology and Regional Pharmacovigilance Center, University Hospital, Basel, Switzerland

Note: [] Correspondence: Nicole Ritz, MD, PhD, Infectious Diseases Unit, University Children's Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland. Tel.: +41 61 704 29 94; Fax: +41 61 704 12 53; E-mail: [email protected]

Abstract: Meropenem is not licensed in infants below three months of age. Off-label use in this age group is common for sepsis, intraabdominal and cerebral infections. We report the case of a 9-week-old infant with an intracerebral Enterobacter cloacae abscess, who developed neutropenia after 19 days of treatment with meropenem. A literature search revealed only one other case report of meropenem-associated bone marrow aplasia in a 3-year old child. An additional search using the World Health Organization Global Individual Case Safety Report database from the Collaborating Centre for International Drug Monitoring showed eight reports of haematological adverse events in children between 2 and 9 years of age. Severe neutropenia or agranulocytosis is a rare but serious and potentially life-threatening adverse event of meropenem and should be considered in children at any age who present with leucopenia or agranulocytosis.

Keywords: Carbapenem, aplasia, pharmacovigilance, adverse event, Enterobacter

DOI: 10.3233/JPI-130375

Journal: Journal of Pediatric Infectious Diseases, vol. 8, no. 1, pp. 49-52, 2013